Proclaim the WORD. Transform Lives.
Word International Ministries Ireland

Census

    Please use form below to enter your complete details as part of the Annual Church Census. If answer is "None" pls indicate "N/A" instead of leaving the fields blank.

    What primary church do I attend as a member (required)?

    DublinCarrickmacrossCavanKildareCork

    Primary Member's Full Name / Head of the Family (required)

    Primary Members' Email Address

    Date of Birth DD/Month/YYYY (required)

    Age of Primary Member (required)

    Member's Nationality (required)

    Work / Employer

    Work / Employer Address

    Civil Status

    SingleMarriedSeparatedDivorcedWidowedAnnulled

    If Civil Status is "Married", Spouse's Name

    Wedding Anniversary Date

    Your Spouse's Email (if any)

    Spouse Date of Birth DD/Month/YYYY

    Age of Spouse

    Nationality of Spouse

    Work / Employer of Spouse

    Work / Employer Address of Spouse

    Please indicate Spouse's ministry involvement in "Additional Information" below

    Languages Fluently Spoken (Press Ctrl Left Mouse to allow multiple entries) (required)

    If Fluent Language spoken is other than Tagalog, please indicate other Filipino dialects spoken ex. Ilocano, ilongo, Kapampangan, Bicolano

    Full Address of Member (required)

    Mobile Contact Number #1

    Mobile Contact Number #2

    Home Telephone Number

    Office/Work Telephone Number

    Family Medical History and Conditions (if any):


    Member's Children/Dependents/Relatives Information:
    Note: This section is for Children/ Dependents/Relatives that belong to the household/address of the Member's family only. Please follow date format DD/Month/YYY = 01 June 2014. For Children ministry involvement indicate in Additional Information.

    Name of Child/Dependent/Relative #1

    Age of Child/Dependent/Relative #1

    Birthday (DD/Month/YYYY)

    Name of Child/Dependent/Relative #2

    Age of Child/Dependent/Relative #2

    Birthday (DD/Month/YYYY)

    Name of Child/Dependent/Relative #3

    Age of Child/Dependent/Relative #3

    Birthday (DD/Month/YYYY)

    Name of Child/Dependent/Relative #4

    Age of Child/Dependent/Relative #4

    Birthday (DD/Month/YYYY)

    Name of Child/Dependent/Relative #5

    Age of Child/Dependent/Relative #5

    Birthday (DD/Month/YYYY)

    Church and Ministry Background

    Spiritual Birthday (DD/Month/YYYY) - When did I accept Jesus as my Lord and Savior

    Ministries Currently Involved in by Primary Member including Family. If Spouse and Children have different ministries indicate in the Additional Information. (Press CTRL Left Mouse for multiple selections) (required)

    Do you currently hold a leadership role in the church (Yes/No)?

    If Yes, I currently hold this leadership position

    Have I undergone Water Baptism?

    YesYes - I would Like to consider doing it againNo - I would Like to be Water BaptisedNo - I would Like to know more about it firstNo

    What Care Group am I / my family currently involved /belong in? (required)

    If the answer to the above question is "None", I would I like to join the Care Group (List CG name here from list above)

    Which Church event do I look forward to the most (Select only one)?

    Youth Camp / Family CampCouple's NightChristmas PartyAnniversaryDaily Vacation Bible School (DVBS)Family DaySports DayWorker's RetreatMother's/ Father's Day ServicePrayer and FastingEaster Service

    Ministries I would like to be involved in. If Spouse and Children have other ministry involvement and preferences, please indicate in Additional Information (Check multiple entries) (required)

    Helps / Seeds of HopePrayer MinistryOutreach and MissionsPraise and Worship MusicianPraise and Worship Back-up SingerTambourine Dance MinistryMedia / Audio Visual / ProjectionistWebsite Design and AdminAttendance / Follow-up (Internal)Follow-up and Care (External)Creative DanceChoirPrinting (Program/Designs)Catering/Food/CookingSpecial Occasions DecoratingChurch Promotions/MarketingVideo ProductionsMedical MissionsCarpentry / Plumbing/ Electrical/ CablingSeaman's MinistryLibrary and Missions StoreChildren's MinistryYouth Ministry LeadingEvent OrganizingChrists' Carpenters (Men's Ministry)WinGs (Women's Ministry)Couple's Ministry / Couple's NightWelcoming / Ushering / AnnouncementsSunday Service CoordinationPuppet Ministry / Drama / ActingFamily / Youth CampsChariots of Blessing (Hatid -Sundo) / DrivingAdministration / FinanceCare Group Leading / Asst LeadingDiscipleship Teaching - AdultsDiscipleship Teaching - Youth / KidsStreet EvangelismFund RaisingSound Booth / Audio TechnicianChurch CleaningParking Lot MinistryInventory Management / Property CustodianProgram Hosting (Master of Ceremonies)Art / Poster/ Stage Backdrop DesignYoung Adults/Singles MinistryFilipino Community Network RepresentativePastoring and ShepherdingMusical Instrument TeachingPhotographyLeadership Council/PLT/Board

    What Musical instrument/s I have most proficiency with?

    GuitarBass GuitarDrumsKeyboardPianoViolinOthers -List in Additional Information

    My skill level in the instrument I'm proficient with

    Additional Information that we need to know from you (If more than 5 Children/Dependent/Relatives list Names, Ages and birthdays here)

    Any suggestions how we (your church leaders/workers) can further improve our church service to you?

    I hereby declare that all the information I stated above are true and only for use for the purpose of the Annual Census of the WIN Ireland. WIN Ireland shall not use this information without consent from me. Thank you